Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 036-091407 | IL |
NPI | 1407809635 |
---|---|
Provider Name | Dr. Sung-Lana Kim |
First Address | Chicago, IL 60675-6581 |
Second Address | Orland Park, IL 60467 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 22/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036091407 | BLUE CROSS BLUE SHIELD PROVIDER NUMBER (01) | IL |
036-091407 | STATE LICENSE (01) | IL |
200029585 | RAILROAD MEDICARE PROVIDER NUMBER (01) | IL |
G52737 | (02) | IL |